Healthcare has now become a critical leverage area where action can have the maximum impact. Government’s development wisdom is now focused on identifying strategic leverage points rather than fixing everything everywhere. 

Inclusive growth is now perhaps the strongest buzzword in development discourse. We have all been talking about growth without understanding that development interventions will not be effectual if they don’t benefit all sections of society. The illusion of trickle-down and ripple-effects of growth had kept us on the wrong track for quite long.

Development programmes have delivered good outcomes for some segments of society, but sadly only marginal or zero sum for others. It is this realisation that has prompted policy-makers to draft strategies that can deliver outcomes that benefit everyone.

As the Organization for Economic Co-operation and Development (OECD) puts it: “Adults in good health are more productive; children in good health do better at school. This strengthens economic performance, and also makes economic growth more sustainable and inclusive”.

India now seems to have awakened to the glaring realities of its healthcare system. The National Health Policy 2017, the first comprehensive health policy document after the last policy was issued 15 years ago in 2002, is an evidence of this intent. As Prime Minister Narendra Modi put it, “The National Health Policy marks a historic moment in our endeavour to create a healthy India where everyone has access to quality healthcare.” 

Non-communicable diseases

The NHP reckons four major contextual changes that perhaps motivated the overall policy approach: Increasing burden of non-communicable diseases (NCDs) and certain infectious diseases; robust growth of the healthcare industry; high incidence of catastrophic healthcare spending by households; and an enhanced grow-th-enabled fiscal capacity of India.

CRHP is a comprehensive approach to primary health care at the community level, mobilizing communities to use simple tools, adapted to the local context, to address priority health needs. In 1972, the World Health Organisation officially recognized CRHP’s pioneering work in villages, also known in the global health community as the Jamkhed model.

The innovation of this approach lies in involving the communities themselves, especially those who are poor and marginalised, in designing their health and development programmes. Through their ‘Shodh Gram’ hospital, the Bangs operate their home-based new-born care model. This model does not depend upon doctors, nurses, hospitals or expensive equipment. It empowers women to use simple medical knowledge and skills to save their new-borns.

The insistence that patients must be treated in ‘techno-centric’ hospitals by Western-trained physicians is to the minds of Bangs, ridiculous, particularly in rural India, where lack of transport and low-income levels make modern healthcare inaccessible.

Swayam Shikshan Prayog

A relatively recent innovation is the Arogya Sakhi model promoted by Prema Gopalan in western Maharashtra who established the acclaimed non-profit Swayam Shikshan Prayog (SSP), which selects and trains women who are landless, but have basic education, are interested in healthcare and community service.

These Arogya Sakhis are equipped with health devices, such as glucometers, blood pressure machines. Along with a mobile tablet, they visit rural women door-to-door to conduct basic medical tests.

Public policy needs to actively promote those innovations that can accelerate our journey to universal healthcare: Increased access, quality and affordability of health care; increased responsiveness of the system to healthcare needs; greater health equity; autonomy in healthcare choices; and above all, improvements in the social determinants of healthcare.